1144265976 NPI number — LSUHSC-S SCHOOL OF ALLIED HEALTH

Table of content: (NPI 1144265976)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144265976 NPI number — LSUHSC-S SCHOOL OF ALLIED HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LSUHSC-S SCHOOL OF ALLIED HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LSU HEALTH SHREVEPORT - ALLIED HEALTH CLINICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144265976
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1450 CLAIBORNE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71103-4204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-813-2972
Provider Business Mailing Address Fax Number:
318-813-2975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 CLAIBORNE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71103-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-813-2970
Provider Business Practice Location Address Fax Number:
318-813-2981
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DUNN
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
DEAN, SAHP
Authorized Official Telephone Number:
318-813-2901

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  196550 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 196550 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: 196550 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 460883 . This is a "MEDICARE ID" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1174173 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com